The 2020 ISG Provider Lens™ Healthcare Digital Services Report

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Healthcare Digital A research report Services comparing provider strengths, challenges U.S. 2020 and competitive differentiators

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Customized report courtesy of: March 2021 ISG Provider Lens™ Quadrant Report | March 2021 Section Name About this Report

Information Services Group Inc. is solely responsible for the content of this report. Un- ISG Provider Lens™ delivers leading-edge and actionable research studies, reports less otherwise cited, all content, including illustrations, research, conclusions, assertions and consulting services focused on technology and service providers’ strengths and and positions contained in this report were developed by, and are the sole property of weaknesses and how they are positioned relative to their peers in the market. These Information Services Group Inc. reports provide influential insights accessed by our large pool of advisors who are actively advising outsourcing deals as well as large numbers of ISG enterprise clients The research and analysis presented in this report includes research from the ISG who are potential outsourcers. Provider Lens™ program, ongoing ISG Research programs, interviews with ISG advisors, briefings with services providers and analysis of publicly available market information For more information about ISG Provider Lens™ studies, please email from multiple sources. The data collected for this report represents information that [email protected], call +1.203.454.3900, or visit ISG Provider Lens™. ISG believes to be current as of December 2020 for providers who actively participated as well as for providers who did not. ISG recognizes that many mergers and acquisitions have taken place since that time, but those changes are not reflected in this report.

All revenue references are in U.S. dollars ($US) unless noted.

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© 2021 Information Services Group, Inc. All Rights Reserved. 1 Executive Summary © 2021 Information Services Group, Inc. All Rights Reserved. Reproduction of this publication in any form without prior 4 Introduction permission is strictly prohibited. Information contained in this 13 Payer Digital Transformation Services report is based on the best available and reliable resources. Opinions expressed in this report reflect ISG’s judgment at the 18 Provider Digital Transformation Services time of this report and are subject to change without notice. 24 Payer Business Process as a Service ISG has no liability for omissions, errors or completeness of information in this report. ISG Research™ and ISG Provider Lens™ 28 Methodology are trademarks of Information Services Group, Inc. ISG Provider Lens™ Quadrant Report | March 2021 Section Name Executive Summary EXECUTIVE SUMMARY

The global pandemic of COVID-19 unquestionably accelerated the move to digital services Interoperability remains a challenge for the industry, resulting in inadequate data sharing, in the healthcare industry. However, ISG considers this the acceleration of pre-pandemic especially between payers and providers. The Fast Healthcare Interoperability Resources activity by healthcare providers and payers to enhance operations, reduce costs and (FHIR) standard was developed to exchange health information. In December, the U.S. Cen- improve engagement with their stakeholders using digital services. ters for Medicare and Medicaid Services (CMS) issued a proposed rule to require Medicaid, Children’s Health Insurance Program (CHIP) and Qualified Health Plan (QHP) programs to For years, new players have been entering the healthcare markets from the technology build HL7 FHIR-based APIs to support data exchange and prior authorization. The rule also solutions business, including hyperscale cloud behemoths such as Amazon, Google and includes a proposed API standard for healthcare operations nationwide. The 21st Century Microsoft. In October 2020, Microsoft released Microsoft Cloud for Healthcare, which Cures Act: Information Blocking, Interoperability, and the Office of the National Coordinator includes data models, cross-cloud connectors, workflows, application programming for Health Information Technology (ONC) Health IT Certification Program Final Rule (ONC interfaces (APIs) and built-in healthcare-specific components, along with its horizontal cloud Cures Act Final Rule) requires health IT developers to comply with a set of certifications, apps and services. Salesforce Health Cloud is a popular healthcare customer relationship APIs and other data access improvements. In April, also to address interoperability Google management (CRM) solution supported by most service providers in this study. At present, Cloud rolled out the general availability of Cloud Healthcare API, a tool to make it easier for health technology stalwarts such as Allscripts, Cerner and Optum are expanding their health systems and providers to connect data across different sources and share that data service offerings, posing a competitive threat to traditional IT service providers. with patients. In December, Amazon Web Services (AWS) launched HealthLake for storage The service providers in this industry are ready for a change not only because of new and analysis of data, automatically structured into the FHIR standard. All the service entrants and the shift to digital and cloud but also because of contract expiration. According providers in this study embrace the FHIR standard in their digital transformation programs. to ISG Research, between 2021 and 2023, a total of 384 IT outsourcing (ITO) deals are Automation is key to digital services as healthcare enterprises gradually adopt robotic expected to expire in the healthcare industry in North America. Application development process automation (RPA) and artificial intelligence (AI) technologies to improve specific and management (ADM) and infrastructure, as well as pure ADM services, account for about processes, including claims processing, medical diagnosis and patient care management. 74 percent of the total expiring deals by total contract value. As healthcare companies in With the ongoing COVID-19 pandemic, there is an increased adoption of telemedicine the U.S. seek to control costs and change with the market, digital transformation is growing, systems as doctors must overcome lockdowns and reduce in-person exposure risks to along with business process as a service (BPaaS).

treat their patients. Healthcare providers are deploying connected healthcare monitoring ecosystems will determine the “new future” for healthcare payers and providers. It is against devices at an explosive rate: According to the Consumer Technology Association, the U.S. this backdrop that digital services will be central to positive outcomes in health and the shipment revenue rose by 73 percent in 2020 and is forecast to reach US$1.2 billion by health business. 2024. Security is an essential component of a digital services ecosystem for employee Payer Digital Transformation Services productivity and patient record protection. In addition, ride-hailing platform companies

are joining with their own services. Lyft Healthcare already provides non-emergency According to the U.S. Census Bureau, the percentage of people with health insurance medical transportation (NEMT) services in the U.S., and it recently partnered with Anthem, coverage for all or part of 2019 (the most recent year studied) was 92 percent, and private JPMorgan Chase, United Way and others to get people in underserved communities to health insurance continued to be more prevalent than public, covering 68 percent and 34 COVID-19 vaccination sites. percent of the population, respectively. However, the insured are dissatisfied with their

The COVID-19 pandemic will continue to influence the behavior of U.S. policymakers, health insurance companies. The American Customer Satisfaction Index (ACSI) shows that citizens and companies in the healthcare ecosystem in 2021 as they take a fresh look at Americans were less satisfied with their health insurance in 2020, and the discontent is the business of healthcare management in the war against this disease that is dragging permeating nearly the entire industry. Member satisfaction weakened by 2.7 percent to an onward. In early January 2021, the U.S. Department of Health and Human Services (HHS) ACSI score of 72, bringing the industry to its lowest point since 2016. Claims are becoming renewed the declaration of the public health emergency from the COVID-19 pandemic, harder to submit and processing is taking longer. However, the U.S. payers seek to remedy extending key waivers for regulations on services such as telehealth until April. Recent these issues, and digital transformation helps them meet member service requirements, executive actions from the new presidential administration to help quell the pandemic changing regulations and competitive pressures. Payers measure the success of technology include commitments to government assistance in prevention, care and treatments for investments based on business outcomes, so finance and other business leaders − not IT − COVID-19 and to the supply chain and worker health. In the next few years, the healthcare often drive digital transformation.

industry services for all aspects of care will look radically different. Governmental and Payers are using RPA to automate mundane back-end business processes such as price intergovernmental agencies are building new frameworks for disease response and data estimates using predefined rules, documentation of insurance contracts, claims notification sharing. Public and private alliances and collaborations are emerging and will be mandat- and verification processes across their value chain. Many payers apply AI in the back office ed soon. Regulations, spending priorities and the current resiliency posture of healthcare by combining multiple data sources to interpret clinical data to improve services. Healthcare

payers require a frictionless flow of information between sales and service channels. By clients move toward it through digital transformation. Investments in cloud solutions to leveraging automation, payers can significantly lower costs, enable faster decision-making help enable digital services are driven in part by the need for greater agility in the time of a and focus on product and service innovations. More advanced technologies such as pandemic, coupled with the growing expectation for transparency through easily accessible blockchain are rarely used, despite use cases such as sharing patient data records. portals and mobile solutions.

Accenture, Cognizant, HCL, IBM, Infosys, NTT DATA, Optum, TCS, UST and Wipro are Healthcare providers are increasingly introducing wearables and other sensors to monitor identified as leaders, while EXL and Genpact are the Rising Stars. patient health and influence the course and choices of patient care. Digital channels that are centered around the patient can dramatically influence wellness, facilitate the capture Provider Digital Transformation Services of data to improve efficacy of treatments and feed other applications to monitor and better

Healthcare providers are in crisis. In the U.S., the COVID-19 pandemic has overloaded manage diseases. hospitals, stalled elective procedures and reduced productivity, with many professionals Accenture, Cognizant, Genpact, IBM, NTT DATA, UST and Wipro are identified as leaders, are unable to do their jobs, all of which has erased profits. The ACSI measures patient while Conduent is a Rising Star. satisfaction with hospitals (including inpatient, outpatient and emergency room services) as well as ambulatory care (office visits to doctors, dentists, optometrists and mental Payer Business Process As A Service health professionals). Following a sharp drop last year of more than 5 percent, patient Automating business processes is critical to payers seeking to reduce costs and streamline satisfaction with hospitals fell to the lowest level in nearly two decades. For ambulatory services. Business process as a service (BPaaS) reduces TCO by breaking silos and optimiz- care, patient satisfaction retreated for the first time in five years, dropping to an all-time ing costs. It also helps payers modernize their operations and accelerate their transition low. to a VBC model. Operational flexibility is another benefit that is considered important in In response, healthcare providers are changing from a fee-for-service to a value-based pandemic and post-pandemic times. Cloud infrastructure supports modernization of payer care (VBC) delivery model, as patients are increasingly expecting personalized and cost-ef- infrastructure as well as movement to enterprise agility, which will help the service providers fective care. Digital services are facilitating greater value at reduced cost with minimal in this study that excel in BPaaS to offer strong cloud migration services. touch interactions. In addition, VBC is shifting the healthcare paradigm from “disease Accenture, Cognizant, HCL, IBM, Infosys, NTT DATA, Optum, TCS, UST and Wipro are care” to “health outcomes.” The service providers in this study embrace VBC and help their identified as leaders, while EXL and Genpact are identified as Rising Stars.

Introduction Introduction

Definition

Simplified Illustration The healthcare and life sciences industries are, more than ever, under pressure to change. The COVID-19 pandemic and public demand for more Healthcare Digital Services 2020 effective outcomes are mandating the acceleration of actions needed to better meet care lifecycle requirements and build patient-centric business models. All segments of the industry are being compelled to comply with Payer Digital Provider Digital Payer Business Process new regulations, integrate waves of competitive mergers and acquisitions Transformation Services Transformation Services As A Service and adapt to the needs of the aging population. However, blockbuster mergers have precipitated costly integration efforts. Also, consumers expect Source: ISG 2020 advanced and convenient digital service delivery. At the same time, many companies are struggling to keep pace with growing demands for their services and increasing competitive pressures.

Definition (cont.)

Scope of the Report

Digital transformation helps address many of the current and anticipated industry challenges. In the U.S. healthcare industry, digital transformation services help payer and provider segments evolve to better serve their constituents. As payers shift the focus of their purchase decisions to business outcomes, finance and other business leaders are driving digital transformation. While some enterprises do it themselves, others use BPaaS solutions. This report covers Healthcare Digital Services in the U.S. across three quadrants, shown below. A second report covers Healthcare Digital Services in Germany and a third covers Life Sciences Digital Services globally.

Provider Classifications

The provider position reflects the suitability of IT providers for a defined market Midmarket: Companies with 100 to 4,999 employees or revenues between US$20 million and segment (quadrant). Without further additions, the position always applies to all US$999 million with central headquarters in the respective country, usually privately owned. company sizes classes and industries. In case the IT service requirements from Large Accounts: Multinational companies with more than 5,000 employees or revenue above enterprise customers differ and the spectrum of IT providers operating in the local US$1 billion, with activities worldwide and globally distributed decision-making structures. market is sufficiently wide, a further differentiation of the IT providers by performance is made according to the target group for products and services. In doing so, ISG either considers the industry requirements or the number of employees, as well as the corporate structures of customers and positions IT providers according to their focus area. As a result, ISG differentiates them, if necessary, into two client target groups that are defined as follows:

Provider Classifications

The ISG Provider Lens™ quadrants are created using an evaluation matrix containing four segments (Leader, Product & Market Challenger and Contender), and the providers are positioned accordingly.

Leader Product Market Contender Challenger Challenger

The Leaders among the vendors/ The Product Challengers offer Market Challengers are also very Contenders still lack mature products providers have a highly attractive a product and service portfolio competitive, but there is still and services or sufficient depth and product and service offering and a that provides an above- significant portfolio potential and breadth in their offering, but also show very strong market and competitive average cover¬age of corporate they clearly fall behind the Leaders. some strengths and improvement position; they fulfill all requirements requirements, but are not able to Often, the Market Challengers potential in their market cultivation for successful market cultivation. provide the same resources and are established vendors that efforts. These vendors are often They can be regarded as opinion strengths as the Leaders regarding are somewhat slow to address generalists or niche players. leaders, providing strategic impulses the individual market cultivation new trends due to their size and to the market. They also ensure categories. Often, this is due to the company structure, and therefore innovative strength and stability. respective vendor’s size or weak have some potential to optimize footprint within the respective their portfolio and increase their target segment. attractiveness.

Provider Classifications (cont.)

Each ISG Provider Lens™ quadrant may include a service provider(s) which ISG believes has strong potential to move into the Leader quadrant. This type of provider can be classified as a Rising Star. Number of providers in each quadrant: ISG rates and positions the most relevant providers according to the scope of the report for each quadrant and limits the maximum of providers per quadrant to 25 (exceptions are possible).

Rising Star Not In

Companies that receive the Rising Star award have a promising The service provider or vendor was not included in this portfolio or the market experience to become a leader, including the quadrant. There might be one or several reasons why required roadmap and adequate focus on key market trends and this designation is applied: ISG could not obtain enough customer requirements. Rising Stars also have excellent management information to position the company; the company does and understanding of the local market. This award is only given to not provide the relevant service or solution as defined for vendors or service providers that have made significant progress each quadrant of a study; or the company did not qualify toward their goals in the last 12 months and are expected to reach the due to market share, revenue, delivery capacity, number Leader quadrant within the next 12-24 months due to their above- of customers or other metrics of scale to be directly average impact and strength for innovation. compared with other providers in the quadrant. Omission from the quadrant does not imply that the service provider or vendor does not offer this service or solution, or confer any other meaning.

Healthcare Digital Services - Quadrant Provider Listing 1 of 2

Payer Digital Provider Digital Payer Business Process Transformation Services Transformation Services as a Service

Accenture 4 Leader 4 Leader 4 Leader

Allscripts 4 Not in 4 Product Challenger 4 Not in

Atos 4 Product Challenger 4 Leader 4 Not in

Birlasoft 4 Not in 4 Contender 4 Not in

Cerner 4 Not in 4 Leader 4 Not in

CGI 4 Contender 4 Not in 4 Not in

Cognizant 4 Leader 4 Leader 4 Leader

Conduent 4 Contender 4 Not in 4 Rising Star

Deloitte 4 Contender 4 Market Challenger 4 Not in

DXC 4 Product Challenger 4 Product Challenger 4 Not in

emids 4 Product Challenger 4 Product Challenger 4 Not in

EPAM 4 Product Challenger 4 Product Challenger 4 Not in

EXL 4 Rising Star 4 Product Challenger 4 Not in

Firstsource Healthcare 4 Not in 4 Not in 4 Product Challenger

Genpact 4 Rising Star 4 Contender 4 Leader

HCL 4 Leader 4 Leader 4 Not in

Healthcare Digital Services - Quadrant Provider Listing 2 of 2

Payer Digital Provider Digital Payer Business Process Transformation Services Transformation Services as a Service

Hexaware 4 Product Challenger 4 Product Challenger 4 Not in

IBM 4 Leader 4 Leader 4 Not in

Infosys 4 Leader 4 Not in 4 Contender

Leidos 4 Not in 4 Contender 4 Not in

LTI 4 Product Challenger 4 Not in 4 Not in

Mphasis 4 Product Challenger 4 Contender 4 Product Challenger

NTT DATA 4 Leader 4 Leader 4 Leader

Optum 4 Leader 4 Leader 4 Product Challenger

Persistent 4 Product Challenger 4 Rising Star 4 Not in

Sutherland 4 Contender 4 Contender 4 Not in

TCS 4 Leader 4 Market Challenger 4 Market Challenger

Tech Mahindra 4 Product Challenger 4 Product Challenger 4 Contender

UST 4 Leader 4 Rising Star 4 Leader

Virtusa 4 Contender 4 Not in 4 Not in

Wipro 4 Leader 4 Leader 4 Leader

ENTERPRISE CONTEXT Payers Digital Transformation Services

This report is relevant to healthcare payer enterprises across the U.S. for evaluating intelligent automation to claims processing is one of the strongest levers that payers can providers offering digital transformation services such as back-office automation services pull to achieve unprecedented levels of operational efficiencies and drive down costs. and clinical data management services to healthcare payer enterprises. In the U.S., some providers offering digital transformation services to healthcare payers In this quadrant report, ISG highlights the current market positioning of service providers also offer provider digital transformation services and payer business process as a service that offer digital transformation services to healthcare payer enterprises in the U.S. and how (BPaaS). Enterprises are looking for trustworthy and committed partners that can address each provider addresses the key challenges faced in the region. the challenges and provide a roadmap for setting up an optimal IT infrastructure.

It is widely known that healthcare lags other industries in the adoption of digital technology, Healthcare payers and IT and technology leaders should read this report to understand mainly due to legacy practices, regulatory obstacles and privacy requirements. However, the relative positioning and capabilities of providers and thus effectively plan and select the pandemic brought on by the COVID-19 outbreak has forced healthcare payers the appropriate digital services and solutions. The report also shows how the technical and regulators to develop interim solutions that facilitate a swifter adoption of digital and integration capabilities of a service provider compare with the rest in the market. technologies. Digital transformation professionals should read this report to understand how Compared with other industries, healthcare payers often have less control over factors that providers of healthcare digital transformation services fit their digital transformation are fundamental to their operations and profitability. Frequent regulatory changes, peaks initiatives and how they compare with one another. and valleys in claims volume and healthcare innovations all have a significant influence on Government, procurement and vendor management professionals should read this the industry. In the face of these challenges, health insurers are constantly on the lookout report to develop a better understanding of the current landscape of service providers for areas where they can optimize. Digital technologies such as robotic process automation offering digital transformation for healthcare payers in the U.S. (RPA) and artificial intelligence (AI) have opened a wide range of opportunities for payers to should read this report to see how service providers address the achieve unprecedented gains in efficiency while improving customer engagement. Applying Security leaders significant challenges of compliance and security without compromising patient privacy and experience. 12

Intelligent Business Automation PAYER DIGITAL TRANSFORMATION SERVICES Definition

This quadrant assesses a service provider’s ability to deliver digital transformation services to payers, also known as insurance plan companies in the U.S. and statuary health insurance companies in Germany. Digital transformation services help payers progressively prioritize a digital-first pathway to improve patient care. The services should help these insurance companies reach and serve their members wherever they are, via computers, remote monitors, smartphones and other mobile devices. The services should also address payers’ operational processes, such as claims processing, member verification and enrollment. Service modernization capabilities should also be clear.

PAYER DIGITAL TRANSFORMATION SERVICES Eligibility Criteria Observations

Platform consulting for the use of the right emerging healthcare Accenture is one of the largest service providers to U.S. healthcare payers. Accenture has technologies, with the ability to plan, develop and implement acquired 20 companies with digital heritage, now offered via its Accenture Interactive, Accenture consumer-grade interfaces of employee systems and member Analytics and Accenture Mobility units and innovation centers in the U.S. information sources, including mobile apps Cognizant’s TriZetto suite is a healthcare-specific solution for payers. The firm spent US$1.4 Established or emerging basic/standard relationships with trusted billion in 2020 on acquisitions, including those supporting payer digital transformation, such as partners, including startup innovators purchases of companies with expertise in cloud, configure-price-quote (CPQ) and billing, digital consulting, digital marketing and ServiceNow. Ability to provide services for digitization of processes while navigat- ing regulation complexities HCL strengthened its digital health offerings with acquisitions, including Actian for data integration and analysis; seven IBM software products for security and digital experience; and Ability to provide consultation services on the development of Strong-Bridge Envision for digital transformation consulting. It has as clients U.S. regional plans models using AI, machine learning (ML) and analytics such as the single-state or regional plans in the Blue Cross Blue Shield Association (Blues). Experience in large transition projects that include consolidation of IBM leverages its unmatched market presence, cloud capabilities, R&D and Watson Health to merged companies and modernization of systems and applications offer service to the U.S. payers.

PAYER DIGITAL TRANSFORMATION SERVICES Observations (cont.)

Infosys Healthcare Platform (IHP) offers the U.S. payers an AI-first TCS offers U.S. payers cloud and digital transformation with data analytics as well as operating business strategy to support decisions that improve member model transformation services. experience and achieve higher efficiencies. UST serves healthcare as a core industry, growing at double-digit rates. NTT DATA has honed its U.S. healthcare payer services strategy over Wipro services the top ten commercial U.S. health plans, three-quarters of the Blues and many several decades. The company includes the former Dell Services individual, Medicare and Medicaid plans. Its portfolio of services goes across the payer value and more recent acquisitions in the U.S., which include Cognosante chain, including claims administration, member management, provider management, care Consulting, a provider of health IT solutions, business process out- management and administration. sourcing services and consulting, as well as Nete, a provider of digital services to the U.S. Department of Health and Human Services. EXL (Rising Star) launched the EXL Health brand in 2020 with many healthcare domain experts. EXL claims six of the top ten U.S. healthcare payers as clients. Optum is a large subsidiary of UnitedHealth Group, the largest healthcare company in the world. The OptumInsight unit will Genpact (Rising Star) has an alliance with Deloitte that, if it can extend beyond Finance and combine with recently acquired Change Healthcare to form a health Accounting, gives payers a reliable combination of expertise in process, domain and digital. technology-centric products and services giant. Genpact also partners with Plexis for payer administration and claims processing, as well as with AWS, IBM and Microsoft for cloud.

NTT DATA Overview Caution NTT DATA Corp. provides IT services worldwide via 133,000 employees and generated US$21 billion in annual NTT DATA continues to work on improving the branding of its digital transformation revenues. It is part of the NTT Group, one of the world’s largest telecommunications and IT companies and the services for healthcare payers so that the market understands its differentiators. world’s 55th-largest company overall. The U.S. is served via NTT DATA Services, headquartered in Plano, Texas. Healthcare is one of the six focus industries, and NTT DATA has serviced healthcare and life sciences clients for more than 45 years.

Strengths

Patient-centered, technology-enabled services for payers: NTT DATA has six designated focus areas for digital enablement, which include IT optimization, data and intelligence, customer experience, Internet of Things (IoT), intelligent automation and cybersecurity. For claims adjudication, there is an automation toolkit for use across a variety of health plans, platforms and connectivity methods. An intelligent decision toolset reduces configuration efforts for new customer implementations. An enterprise conversational AI platform providers 24x7 omnichannel virtual agent capabilities. Other toolsets help screen, score and coordinate benefits to improve payment integrity and revenue recoveries. 2021 ISG Provider Lens™ Leader Invests in payer-specific AI innovations: The AI-based Chronic Disease Prediction and Intervention solution helps in the early identification of patients at risk for certain chronic diseases, which may be critical in enabling early and effective prevention. It uses large data sets from multiple payers, providers and pharmaceutical NTT DATA offers decades of experience and companies. Digital healthcare is a focus of the company’s medium-term management plan. ongoing presence serving U.S. health plans, Robust partnership ecosystem: To complete its payer offerings, NTT DATA works with service partners such with extensive domain expertise and a strong as Oracle, Cedargate and Dynamic Healthcare, as well as with health tech firms including HealthEdge, Plexis and foundation of digital services. Simplify Healthcare. NTT DATA integrates its consumerism and digital health platform with the Smile CDR CMS interoperability solution. Larger partners are Salesforce and Oracle for health offerings and Dell Technologies, Microsoft, AWS and GCP for cloud.

ENTERPRISE CONTEXT Provider Digital Transformation Services

This report is relevant to healthcare provider enterprises in the U.S. for evaluating suppliers Healthcare providers seek trustworthy and committed partners that can address the of digital transformation services. challenges and provide a roadmap for digital services.

In this quadrant report, ISG highlights the current market positioning of providers that offer Healthcare professionals and IT and technology leaders should read this report digital transformation services to healthcare providers in the U.S. and how each provider to understand the relative positioning and capabilities of service providers and thus addresses the key challenges faced in the region. effectively plan and select the appropriate services and solutions. The report also shows how the technical and integration capabilities of a service provider and its market Due to the COVID-19 pandemic, there has been a rapid evolution of government presence compare with the rest in the market. regulations, technology innovation and patient expectations. Starting right before the pandemic and expanding into it, healthcare providers have realized that running a medical Digital transformation professionals should read this report to understand how practice is not just about patient treatment anymore. It is also about enriching the patient suppliers of digital transformation services for healthcare providers fit their initiatives and experience and driving improved health outcomes. how they compare with one another.

In the U.S., Population Health Management (PHM) is concerned with people’s healthcare Government, procurement and vendor management professionals should read this needs and offers services accordingly. Enterprises are focusing on technology-based report to develop a better understanding of the current landscape of providers offering services that leverage data-driven automation, analytics and artificial intelligence (AI) to digital transformation services to healthcare providers in the U.S. build virtual assistants and co-create telehealth solutions. With a sense of urgency resulting Security leaders should read this report to see how service providers address the from the pandemic, they are also looking for digital transformation services related to smart significant challenges of compliance and security without compromising the patient healthcare diagnosis, back-end operations, augmented reality (AR) and virtual reality (VR) to experience. make timely and informed decisions.

© 2021 Information Services Group, Inc. All Rights Reserved. ISG Provider Lens™ Quadrant Report | March 2021 Artificial Intelligence for IT operation (AIOps) - Large Accounts PROVIDER DIGITAL TRANSFORMATION SERVICES Definition

This quadrant assesses service providers that offer digital transformation services to healthcare providers such as hospital systems and independent healthcare providers. They should be responsible for processes and systems for patient relations and care, such as intake, physician referral management, ambulatory and chronic care and post-acute care. The services should also include employee systems such as information portals, scheduling and collaboration.

PROVIDER DIGITAL TRANSFORMATION SERVICES Eligibility Criteria

Ability to plan, develop and implement consumer-grade interfaces Ability to advise on workforce development, including upskilling to support digital and data of hospital and office systems as well as patient information and privacy protection monitoring sources, including mobile apps for wellness, medical Consulting on the development of models using AI and analytics for screening, diagnostics and reference and fitness treatment Capability to offer guidance on selecting and deploying telehealth Platform consulting for the use of the right emerging healthcare technologies, such as telehealth solutions, including measures for cybersecurity services, remote patient monitoring (through IoT and wearables), blockchain for data sharing, Established or emerging basic/standard relationships with trusted robotics and electronic prescription services partners, including emerging disruptors with new models of care Experience in large transition projects that include consolidation of merged companies and delivery modernization of systems and applications

PROVIDER DIGITAL TRANSFORMATION SERVICES Observations

Accenture incorporates human-centered design into its healthcare HCL acquired Strong-Bridge Envision, a Delaware company that provides digital transformation provider services while focusing on privacy and security of patient strategy consulting, digital/Agile program management and organizational change management, data. as well as Actian for healthcare data integration and analytics. Acquired IBM products enhance HCL’s patient experience and digital transformation support. Atos leads with a digital hospital model based on innovation and science, while enabling decarbonization. In 2020, Atos acquired several IBM remains one of the largest and most trusted providers of technologies and services. In small companies in the U.S. that offer technologies and consulting response to the pandemic, IBM has set up telemedicine stations for doctors to handle remote services in various areas, including Salesforce, AI and data science. diagnosis.

Cerner is a healthcare information technology company serving NTT DATA, with partners, established Nucleus for Healthcare, a framework that incorporates hospitals and health systems. It has been growing its services busi- best-in-class solutions to help accelerate clients’ digital transformation journeys. NTT DATA nesses and is competing now with the traditional service providers. recently acquired Hashmap, a data engineering firm; Flux7, a cloud consulting firm; and Acorio, a ServiceNow workflow company. Cognizant is not only based in the U.S., but its Healthcare and Life Sciences business also has a large presence in the country and Optum Analytics Managed Services applies experts and the OptumIQ tools and data to helping contributes 29 percent of company revenues. It spent US$1.1 billion healthcare providers make informed, data-driven decisions that promote sustainable operations on nine acquisitions in 2020 in data and AI, cloud, digital engineering and success. Optum’s services to providers will expand with the acquisition of Change Health- and the IoT. care.

PROVIDER DIGITAL TRANSFORMATION SERVICES Observations (cont.)

Wipro gives providers a community hub strategy, along with its AssureCare Platform data integration for several devices/protocols, and necessary data security, encryption, compliance and reporting capabilities. It invested in Iora Health, a Boston-based primary care provider network.

Persistent (Rising Star) offers digital front door and other capabilities to U.S. healthcare providers, especially via the Salesforce Health Cloud, to support digital transformations. Persistent is acquiring CAPIOT, which is based in Palo Alto, California, and specializes in enterprise integration with expertise in MuleSoft, Red Hat and TIBCO.

UST (Rising Star) acquired Contineo Health, a New Jersey-based healthcare strategy and technology consulting firm that specializes in electronic medical record (EMR) implementation, optimization, health data reporting, analytics and interoperability. MyDoc is its digital healthcare platform that connects patients, payers and providers to deliver insights from healthcare data and help coordinate care.

NTT DATA Overview Caution NTT DATA Corp. provides IT services worldwide, with 133,000 employees. It generates annual revenue of US$21 Many recent acquisitions and partnerships to expand its business could make NTT billion, making it a member of “The Big 15” in the ISG Index. It is part of Japan’s NTT Group, the world’s 55th-larg- DATA look a bit disjointed to healthcare providers. est company. NTT DATA Services coordinates its U.S. services from Plano, Texas. Healthcare is one of the six focus industries, with 10,000 people dedicated to serving healthcare providers.

Strengths

Digital front door for healthcare: In July, NTT DATA announced a new alliance with Teladoc Health, Enli, VisitPay and R1 RCM to build Nucleus for Healthcare, a framework that incorporates best-in-class solutions to help accelerate clients’ digital transformation journeys. Alliance partners enable virtual care, virtual real-time patient scheduling and intake, population health management and patient financial engagement. NTT DATA’s cloud-based enterprise AI platform uses predictive analytics, automation and integration capabilities to provide a seamless digital fabric and user experience for the various personas within a health system.

AI in medicine: Image analysis is an area of medicine where AI is making early inroads in significantly improving diagnoses and patient outcomes. NTT DATA’s Nucleus for Unified Clinical Architecture offers imaging and 2021 ISG Provider Lens™ Leader analytics collaboration to providers. One of the major partners of NTT Data is MD.ai, an emerging company in imaging research and AI delivery for the clinical imaging space. NTT DATA also collaborates with Google Cloud NTT DATA is leading and growing in the U.S. to develop and deliver solutions with AI, ML and IoT. with its Nucleus for Healthcare framework, COVID-19 response: In addition to helping its clients rapidly move to remote work with healthcare service desk teams, NTT DATA works with Enli’s population health management software to deliver COVID-19 patient care which enables digital transformation for coordination. It also developed a mobile, end-to-end solution on the Salesforce platform to test and trace City of healthcare providers. Austin residents, first responders and testing site workers.

This report is relevant to healthcare payers in the U.S. for evaluating service providers of payer business process as a service (BPaaS). Some payer BPaaS providers in the U.S. also offer digital transformation services to payers

In this quadrant report, ISG highlights the current market positioning of service providers and other providers. Enterprises are looking for trustworthy and committed partners that offering payer BPaaS to enterprises in the U.S. and how each service provider addresses the can address challenges and provide a roadmap for setting up an optimal IT infrastructure. key challenges faced in the region. Digital transformation, IT and technology professionals should read this report to As the healthcare market moves toward managing by outcomes, the BPaaS alternative understand how providers of payer BPaaS fit their digital transformation initiatives, IT is emerging as an elegant strategic option for payers. The pandemic has exacerbated a architectures and cloud strategies. situation in which plan members and healthcare providers are accessible to payers and Business strategy leaders, through this report, will gain knowledge of providers’ product increasingly competent to change. Thus, adopting a BPaaS strategy can lead to stronger portfolio capabilities, which, in turn, can support the selection of services to enable a results as payers can create efficiencies across the operations landscape. It can support streamlined workflow and enhance functionality. connections and orchestrate data flows, allowing payers to operate their businesses more Procurement and vendor management professionals should read this report to efficiently and intelligently. develop a better understanding of the current landscape of healthcare service providers As the BPaaS model continues to evolve, service providers are developing their offerings in the U.S. for digital transformation. The report also shows how the technical and to meet the growing requirements of healthcare payers and demonstrate agility in integration capabilities of a service provider compare with the rest in the market. transforming the way healthcare is experienced by its constituents — members, providers, brokers/agents and regulators.

© 2021 Information Services Group, Inc. All Rights Reserved. ISG Provider Lens™ Quadrant Report | March 2021 Artificial Intelligence for IT operation (AIOps) - Mid market PAYER BUSINESS PROCESS AS A SERVICE

Definition

This quadrant assesses healthcare payer BPaaS for end-to-end outsourcing of business processes across the technology stack to improve business outcomes. The service provider integrates services, processes, applications and infrastructure into a comprehensive service with a clear objective of cost control. Apart from cost savings, BPaaS also promotes improved member and provider experience, operational insights, improved quality of care and regulatory compliance.

PAYER BUSINESS PROCESS AS A SERVICE

Eligibility Criteria Observations

Ability to advise, with focus on outcomes, via member engagement Accenture offers payer BPaaS via its Intelligent Health BPS for common processes and its and financial value metrics Advanced Health Analytics platform. The company also employs thousands of BPS professionals dedicated to healthcare clients. Ability to support any application or platform, including legacy systems Cognizant is one of the leading service providers for U.S. healthcare payers with its industry expertise and tools, cloud and digital portfolio. In 2020, it invested US$120 million in R&D of Established protocols and technologies for integrated security platforms that support its BPaaS solutions. Ability to implement appropriate intelligent automation for specific Genpact serves payers with a strong BPaaS offering that evolved from Genpact’s BPO heritage, business processes a growing focus on digital transformation capabilities and deep domain expertise in the health- Experience implementing and expanding health plan analytics care ecosystem. To bolster its U.S. operations, in January 2021 it acquired Enquero, a small Ability to support back-office, middle-office and front-office business California-based firm that offers data engineering and data-led digital transformation services. processes NTT DATA has a mature and proven offering called Digital BPaaS for Health Plans that instanti- Competencies in integrated governance and performance service ates contract simplicity, utility consumption, intuitive scope, personalized bundles and flexible management consumption units in outcome-based pricing models.

Established or emerging partnerships with application providers, platform companies and infrastructure firms

PAYER BUSINESS PROCESS AS A SERVICE

Observations (cont.)

UST Healthcare-in-a-Box combines its capabilities for payer Core Administration Platform Services (CAPS) with partner solutions for member experience, contact center, document interchange, imaging, payment integrity, financial integrity and population health services.

Wipro BPaaS offers management of the entire payer value chain, including enrollment processing, member billing, fulfillment, care management and claims processing. Wipro recently entered a global strategic partnership with Plexis Healthcare Systems for claims and care management technology.

Conduent (Rising Star) has begun to leverage its contact center and customer experience management in the healthcare payer business. It acquired the U.S.-based Health Solutions Plus (HSP) in 2019 to further enhance its core administration processing capabilities in the healthcare industry.

NTT DATA Overview Caution NTT DATA Corp. provides IT services worldwide. It has 133,000 employees and generates annual revenue of NTT DATA does not have the name recognition of some competitors in the payer US$21 billion. It is part of the NTT Group, one of the world’s largest telecommunications and IT companies and BPaaS market. the world’s 55th-largest company. NTT DATA Services is headquartered in Plano, Texas. Healthcare is one of its six focus industries, and NTT DATA has serviced healthcare payer clients for 50 years.

Strengths

Market presence: NTT DATA has more than 50 clients for its Digital BPaaS for Health Plans, including national, multistate, state and local plans. Its sweet spot is those with 50,000 – 300,000 members in the Medicare, Medicaid and Medicare Advantage segments and payers with 300,000 or more members in a commercial line of business. With a consumer focus, the BPaaS offerings use a high-performance service factory model Business outcomes: with a component architecture, and with integration across business process, applications and infrastructure. 2021 ISG Provider Lens™ Leader Its offerings include automation and analytics, hosted through a secure private, public or hybrid cloud or on premises. NTT DATA offers a range of nearshore and offshore options. The company claims contract simplicity, utility consumption, intuitive scope, personalized bundles and flexible consumption units in outcome-based NTT DATA’s Digital BPaaS for Health Plans pricing models. offers a comprehensive yet flexible solution Digital engagement: Member and provider needs are changing with the pandemic, requiring payers to handle with advanced analytics, intelligent automation more interactions at any time of the day or night. NTT DATA BPaaS offerings include the digital solutions needed services and integrated workflow support. to improve engagement with members and providers. NTT DATA is also venturing its BPaaS into areas where the healthcare provider market integrates with the payer market, actively pursuing touchpoints between the healthcare provider and payer to deliver services to one another in a faster, streamlined, cost-effective manner.

Methodology ISG Provider Lens™ Quadrant Report | March 2021

METHODOLOGY The research study “ISG Provider Lens™ 2020 – Healthcare Digital Services” analyzes the relevant software vendors/service providers in the global market, based on a multi-phased research and analysis process, and positions these providers based on the ISG Research methodology

The study was divided into the following steps

1. Definition of Healthcare Digital Services 5. Detailed analysis & evaluation of services & service documentation based on the facts & figures received from providers & other sources. 2. Use of questionnaire-based surveys of service providers/vendor across all trend topics 6. Use of the following key evaluation criteria: Strategy & vision 3. Interactive discussions with service providers/vendors on capabilities − Innovation & use cases − − Brand awareness and presence in the market 4. Leverage ISG’s internal databases & advisor knowledge & experience − Sales and partner landscape (wherever applicable) − Breadth and depth of portfolio of services offered − Technology advancements

Ron Exler, Author Senior Advisor

Ron Exler is a Director and Principal Analyst with the ISG Provider Lens (IPL) service, a part of ISG Research, leading IPL studies including Internet of Things (IoT) and Healthcare Digital Services. Ron has led product management at enterprise software companies, run enterprise research advisory services, and advised, built and deployed innovative technology inside large enterprises. Ron holds a Master of Science degree in Cartography from the University of Wisconsin as well as a Bachelor of Science degree from Oregon State University. Ron also holds the ISG Digital Xpert certification.

Ammar Mohammed, Enterprise Context and Global Overview Analyst Senior Analyst

Ammar is a lead analyst with ISG Provider Services. At ISG he works on provider workshops, thought papers and IPL studies focused on the Media, Healthcare and Life Sciences industries. He also tracks and assesses digital transformation trends and the impact of emerging technologies across the Healthcare and Life Sciences verticals. During his tenure, he has developed content for ISG Momentum™ and ISG Provider Lens™ in the areas of Healthcare, Life Sciences and Manufacturing industries. He is responsible for supporting research authors and authoring blogs, enterprise content and the Global Summary report with market trends and insights.

Sidanth Prasad, Enterprise Context and Global Overview Analyst Research Analyst

Sidhanth Prasad is a research analyst at ISG and is responsible for supporting Provider Lens™ studies on Healthcare and Lifesciences. During his tenure, he has developed content for ISG Provider Lens™ in the areas of Healthcare and Life Sciences. He is responsible for supporting research authors and authoring blogs, enterprise content and the Global Summary report with market trends and insights.

Jan Erik Aase, Editor Partner and Global Head - ISG Provider Lens™

Mr. Aase brings extensive experience in the implementation and research of service integration and management of both IT and business processes. With over 35 years of experience, he is highly skilled at analyzing vendor governance trends and methodologies, identifying inefficiencies in current processes, and advising the industry. Jan Erik has experience on all four sides of the sourcing and vendor governance lifecycle - as a client, an industry analyst, a service provider and an advisor. Now as a research director, Partner and Global Head - ISG Provider Lens™, he is very well positioned to assess and report on the state of the industry and make recommendations for both enterprises and service provider clients.

ISG (Information Services Group) (Nasdaq: III) is a leading global technology research and advisory firm. A trusted business partner to more than 700 clients, including more than 75 of world’s top 100 enterprises, ISG is committed to helping corporations, public sector organizations, and service and technology providers achieve operational excellence and faster growth. The firm specializes in digital transformation services, including automation, cloud and data analytics; sourcing advisory; managed governance and risk services; network carrier services; strategy and operations design; change management; market intelligence and technology research and analysis. Founded in 2006, and based in Stamford, Conn., ISG employs more than 1,300 digital-ready professionals operating in more than 20 countries—a global team known for its innovative thinking, market influence, deep industry and technology expertise, and world-class research and analytical capabilities based on the industry’s most comprehensive marketplace data. For more information, visit www.isg-one.com.